3.6.3.80 Guidelines to Table 8 - Communication Function

Summary

Table 8 is used where a person has a functional impairment affecting communication functions.

The diagnosis of the medical condition causing the impairment must be made by an appropriately qualified medical practitioner. This includes a general practitioner, a neurologist, a rehabilitation physician, an ear nose and throat surgeon or other relevent specialist.

If a person uses any aids or equipment to assist with their communication function, they must be assessed on their ability to undertake activities listed in Table 8 while using any aids or equipment that they have and usually use without physical assistance from a support person.

Table 8 refers to communication in a person's main language. This is the language a person most commonly uses. This may be the language the person uses at home or their first language and should be their most fluent language.

Table 8 covers both receptive communication, which is understanding language, as well as expressive communication, which is producing speech. Table 8 also covers the use of alternative or augmentative communication such as sign language, technology that produces electronic speech or the use of symbols or a note taker to assist in communication.

A person's self-reported symptoms MUST NOT BE SOLELY RELIED UPON in determining functional impacts of the person's permanent condition (impairment). There must be corroborating medical evidence of the person's impairment, which can include speech pathologist reports.

Determining the level of functional impact - general rules

When determining which impairment rating applies to a person the rating that best describes the person's abilities or difficulties must be applied. In applying the descriptors in Table 8, each descriptor sets out how the points within it are to apply.

For example, to meet the 10-point descriptor either (1)(a), (1)(b) or (1)(c) must apply. If (1)(a) applies then either (1)(a)(i) or (1)(a)(ii) must apply. To meet the 20-point descriptor in Table 8 either (1)(a), (1)(b) or (2) must apply. If (1)(b) applies then at least one of either (1)(b)(i), (1)(b)(ii), (1)(b)(iii) or (1)(b)(iv) must apply. If (2) applies, at least one of (2)(a), (2)(b), (2)(c) or (2)(d) must also apply.

The structure of the Tables requires that, in assessing the level of functional impact, a comparison must be made of all the descriptors for each level of impairment. An assessment starts by considering the descriptors for 0 points and, if a person has more than 'no functional impact', the descriptors for 5 points are then considered, and so on for the descriptors for higher impairment levels. When it is determined that a person meets all the required descriptors for a certain impairment rating level, but does not meet all the required descriptors for the next impairment rating level, the appropriate impairment rating applicable to the person's circumstances will be the lower of those 2 impairment ratings (i.e. the rating at which all the required descriptors are met).

Explanation: Where a person meets the required descriptors for 10 points but does not meet all the required descriptors for 20 points, the correct impairment rating is 10 points. The person's impairment CANNOT be regarded as severe or extreme for the purposes of DSP and neither 20 nor 30 points can be allocated.

Note: Individual descriptors or their parts must not be applied in isolation from one another.

In determining whether the required descriptors for a specific impairment level are met or not, ALL the descriptors for that level must be considered and applied as set out in the descriptor. NO descriptors or their parts are to be disregarded. One of several descriptor points may be sufficient for that rating when the word 'or' links the descriptors.

Determination of the descriptor that best fits a person's impairment level must be based on the available medical evidence including the person's medical history, investigation results and clinical findings and observations made during the assessment process.

Only one rating should be assigned from Table 8 even if the communication or language impairment is both receptive and expressive in nature.

0-point impairment rating level

The 0-point descriptor requires that a person has NO functional impact on communication in the person's main language.

5-point impairment rating level

The 5-point descriptor requires there must be a MILD functional impact on communication in the person's main language and at least one of the descriptors (1)(a) or (1)(b) applies.

10-point impairment rating level

The 10-point descriptor requires there must be a MODERATE functional impact on communication in the person's main language and either (1)(a), (1)(b) or (1)(c) must apply. If (1)(a) applies then either (1)(a)(i) or (1)(a)(ii) must apply.

20-point impairment rating level

The 20-point descriptor requires that there must be a SEVERE functional impact on communication in the person's main language. Either (1)(a), (1)(b) or (2) must apply. If (1)(b) applies, then at least one of either (1)(b)(i), (1)(b)(ii), (1)(b)(iii) or (1)(b)(iv) must apply. If (2) applies, then at least one of (2)(a), (2)(b), (2)(c) or (2)(d) must also apply.

30-point impairment rating level

The 30-point descriptor requires there must be an EXTREME functional impact on communication in the person's main language. Either (1)(a), (1)(b) or (2) must apply. If (1)(a) applies, then at least one of either (1)(i), (ii), or (iii) must apply. If (1)(b) applies, then at least one of either (1)(b)(i), (1)(b)(ii), (1)(b)(iii), or (1)(b)(iv) must apply. If (2) applies, then at least one of either (2)(a), (2)(b), or (2)(c) must apply.

Some conditions causing impairment commonly assessed using Table 8

There are a range of conditions a person may have which cause impairment affecting communication that can be appropriately assessed using Table 8. These include but are not limited to:

  • stroke (cerebrovascular accident (CVA))
  • other acquired brain injury that has damaged the speech/language center of the brain, for example, dysphasia, aphasia
  • cerebral palsy
  • neurodegenerative conditions
  • damage to the speech-related structures of the mouth, vocal cords or larynx.

Example 1: An 18-year-old woman has a diagnosed permanent condition of cerebral palsy, which she has had since birth. The medical evidence states that as a result of this condition the woman's speech is slurred. Sometimes she has difficulty being understood in certain situations so she uses an electronic voice output device at these times.

The condition is considered fully diagnosed, treated and stabilised, and under Table 8, this person would receive an impairment rating of 10-points due to the moderate impact this condition has on her communication function. Under the 10-point descriptor, this would meet (1)(c).

Due to her condition of cerebral palsy, the woman also has impairment in functioning of her lower and upper limbs. Consideration should be given to whether she would also receive an impairment rating for these impairments under Table 2 - Upper Limb Function and Table 3 - Lower Limb Function.

Example 2: A 55-year-old man was treated for laryngeal carcinoma 6 months before applying for DSP. Treatment included a total laryngectomy, primary tracheo-oesophageal puncture (TEP) and insertion of an indwelling voice prosthesis. The man had no post-operative complications and is generally well, with no evidence of recurrence or metastatic spread of the carcinoma. His cancer prognosis has been assessed as good.

The man's post-laryngectomy speech quality, achieved with the guidance of a speech pathologist, is intelligible and closely resembles laryngeal speech. He needs to manually cover the tracheal stoma while speaking, and has good hand dexterity. He has pre-existing well-managed chronic obstructive pulmonary disease (COPD), including mild emphysema, due to a long-term smoking history. He has occasional problems with speech volume and production due to shortness of breath, particularly during COPD exacerbations. Due to post-laryngectomy nasopharyngeal airway dysfunction, he has decreased olfactory acuity (sense of smell).

Due to the post-laryngectomy condition this person would receive a rating of 5-points under Table 8 due to the mild impact on communication function. Under the 5-point descriptor this person would meet (1)(b).

Due to his condition of well-controlled COPD, this person also has impaired functioning under Table 1 - Functions requiring Physical Exertion and Stamina. His condition of partial anosmia is not assessable under the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011.

Example 3: A 60-year-old man experienced a stroke one year ago, which has had a range of impacts, including on his speech clarity. Despite intensive rehabilitation including speech therapy, strangers are unable to understand his speech and he is unable to effectively converse with people. Due to this, he relies upon his partner or children to speak on his behalf at appointments, shops and so forth. He meets (1)(b)(ii) 20-point descriptor.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 Table 2 - Upper Limb Function, Table 3 - Lower Limb Function, Table 8 - Communication Function

Impairments that should not be assessed using Table 8

There are a range of conditions a person may have which cause impairment affecting communication but should not be assessed using Table 8. These include but are not limited to:

  • impairment affecting communication function as a result of hearing loss only
  • impairment affecting communication function as a result of impairment in intellectual function only
  • fluency or competency difficulties in using the spoken English language.

People who use recognised sign language or other non-verbal communication as a result of hearing loss only are more appropriately assessed under Table 11 - Hearing and Other Functions of the Ear. If a person's impairment affecting communication function is due to impairment in intellectual function, it is more appropriately assessed under Table 9 - Intellectual Function.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 Table 8 - Communication Function, Table 9 - Intellectual Function, Table 11 - Hearing and other Functions of the Ear

Last reviewed: